Category: Depression

Empathic Listening

Business Logo for Psychological and Neuropsychological IssuesEmpathy may be defined as the identification with the thoughts, feelings and attitudes of another person.  It sounds like something people experience every day, but it is more an exception than the rule.  If empathy was the rule, the norm, the world would be a much different place.  Empathy runs counter to the human need for people to differentiate themselves from other people.  It runs counter to the need for groups to differentiate themselves from other groups.  It is the proverbial act of putting oneself in the shoes of another person.  Psychotherapists often label the active process of  this identification as empathic listening.

The meaning of empathy is not synonymous with sympathy.  Sympathy is to be in agreement with the thoughts and feelings of another; even to share similar thoughts and feelings as the other person.  This is not the goal of most psychotherapeutic schools, since it may bring a loss of objectivity.  For example, a depressed person may engage in many thoughts and beliefs that enable the depression to flourish.  A sympathetic psychologist may become lost in the many instances of bad luck or even tragedy that befall the person.  Sympathy will render the psychologist blind to the maladaptive aspects of the patient’s behavior, since they are actively and uncritically ingesting the depression of their patient.  Similarly, an anxious patient may experience many negative outcomes as a consequence of their anxiety.  A psychologist that chronically feels sorry for their anxiety is certainly sympathetic, and this may serve to validate the patient’s perceptions, but it is unlikely to alleviate their anxiety in a meaningful fashion.

Along with that you can find and buy a wide range of drugs and pills online which are specially designed in a way cheapest viagra from india to provide you with utmost convenience. The very first thing is that men are willing to visit their doctor in a bid to be good in bed. canadian viagra generic Erectile dysfunction if faced by a person for treating the levitra best prices sexual disorder within them which is why they fail to open up to people next time. Your mental and physical consciousness will inspire other folks heritageihc.com viagra properien to strike you. The act of identification with the patient’s feelings and thoughts will often produce an emotional or intellectual reaction in the psychologist.  A true professional has performed enough personal discovery to understand what their reaction signifies.  For example, many psychologists comment that they become uncomfortable with borderline personality disorder patients.  A well-trained psychologist is aware of their emotional triggers in order to use this information in the service of their patient.  Perhaps the disassociation between the patient’s facial expression(s) and speech reminds the psychologist of their mother.  To become sympathetic to this symptom, or worse enraged, will occur if the psychologist lacks the personal knowledge to understand the historical nature of their reaction.  An empathetic listener identifies with the borderline patient’s thoughts and feelings, but does not lose the critical awareness of their own reactions.  It is the process of understanding and entering into the patient’s thoughts and feelings without falling into a pit of subjectivity.

Empathic listening is less a trait possessed by gifted people than a skill that is learned in a rigorous fashion.  Training to become a psychologist requires many hours of clinical supervision.  Students bring in tapes of psychotherapy sessions and the professors rake the students over the coals of their psychopathology.  It is not uncommon for many students to cry or become angry at the professor’s comments, since they may strike at the heart of what makes us a person.  No one likes to hear someone they respect say, “Why the hell did you say that?”  It is even more threatening when the professor gives a short description of the student’s pathology, and how their mistake will derail the psychotherapy.  It is a highly uncomfortable and valuable process when performed diligently.  It more comfortable and less useful if the professor seeks to spare the student’s feelings-to sympathize with their plight.  Empathic listening is a skill that every competent psychologist must acquire.  Empathic listening is a major factor that differentiates psychotherapy from ordinary conversation.  As a general rule, friends are sympathetic and shrinks are empathetic.

Losing It

Business Logo for Psychological and Neuropsychological IssuesLosing it.  All of us lose “it” at some point.  The “it” appears to be the control exerted by the prefrontal cortex of the brain.  The prefrontal cortex serves many functions, and one of the most important is the inhibition of impulses.  The most common impulses to inhibit are sexual and aggressive urges; though they are not mutually exclusive.  The research of Amy Arnsten at Yale has shown that acute stress releases chemicals that reduces the influence of the prefrontal cortex over these impulses.  Not only is prefrontal control weakened, but more primitive areas of the brain emerge to pick up the slack.

In response to the stress confronting the brain, the less evolved brainstem releases two primary neurotransmitters called dopamine and norepinephrine.  Dr. Arnsten discovered that these neurotransmitters actually diminish the communication between the prefrontal area and other regions of the brain.  Once the regulatory network is down, the base of the brain sends a chemical message to the adrenal glands adjacent to the kidneys, and the adrenal releases a hormone that influences the brain in turn.  Norepinephrine and the adrenal hormone cortisol promotes emotional areas of the brain to be fearful and prepare for possible danger.

Chronic unrelenting stress may actually reduce connections between nerve cells in the inhibitory prefrontal area.  Conversely, nerve connections in the more primitive emotional areas of the brain may expand.  There is some evidence to suggest that shrinkage of neural connections in the prefrontal cortex may play a role in depression, addiction and anxiety disorders.  The neurotransmitter dopamine has been long implicated in addiction, due to its strong influence on habit forming areas of the brain.  It appears that a relatively brief exposure to stress has little lasting affect on brain structure.  The longer stress is experienced, the greater the chance the more primitive emotional brain areas will dominate one’s behavior.
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This feedback loop of the brain may play a role in post-traumatic stress disorder.  The habit forming areas of the brain allow us to quickly acquire skills and behaviors that ensure success in novel environments; for example, a war zone.  The prefrontal cortex allows us to formulate plans and inhibit fearful impulses that would reduce effective functioning.  Once the threat is removed, the dangers already experienced may overwhelm the prefrontal cortex’s ability to inhibit the emotional excitement.  Over time, the dopamine, cortisol and norepinephrine may weaken the prefrontal control to the point that the fearful impulses are rarely blocked.  The unfortunate person may re-experience highly emotional scenes in an uncontrolled and repetitive fashion.  This person would experience substantial stress in a peaceful environment, since the brain continues to assault them with feelings and images that inspire fear and avoidance.

It is still a mystery why some people manage chronic stress well, and others-not so much.  It is conjectured that some lucky people have an enhanced ability to digest the dopamine and epinephrine excreted during stress. They would possess an innate biological resistance to stress.  On the other hand, psychological research has revealed that people with a long record of mastering challenging situations are better able to tolerate stress.  People who are often defeated and overwhelmed by events are more liable to suffer with chronic stress and depression.  A person’s perception of control is a key element in the subjective experience of stress.  To what degree the subjective sense of control is a product of training or brain chemistry is anyone’s guess.  As with most psychological phenomenon, it is likely that both elements play an important role.  Effective behavioral training increases a sense of personal control; decreasing the excretion of stress chemicals.  Inheriting favorable brain chemistry may reduce the biological strength of the stress response.  Nature and nurture.  Can’t get away from it.

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